Glossary of voice AI and healthcare phone terms

AI receptionist An AI receptionist is a voice agent that answers a business's phone line, understands what the caller wants from natural speech, and either resolves the request or transfers the caller to the right person. AI voice agent An AI voice agent is software that holds a spoken conversation over the phone, combining speech recognition, a language model and speech synthesis to listen, decide and reply. Warm transfer A warm transfer is a call transfer in which the person receiving the call is told who is calling and why before the caller is connected. Cold transfer A cold transfer, also called a blind transfer, sends a caller to another line without any introduction and without checking that someone answers. Whisper (call whisper) A whisper is a short spoken message played only to the staff member receiving a transferred call, before the caller is joined, saying who is calling and what they need. IVR (interactive voice response) IVR is the automated phone menu that answers a call with recorded prompts and routes the caller according to the keys they press or the words they say. IVR navigation IVR navigation is the work of getting through an automated phone menu to the right department or a live representative, by choosing options and entering identifiers. DTMF (touch-tone) DTMF, or dual-tone multi-frequency signaling, is the set of tones a phone sends when a key is pressed, which automated phone systems use to read the caller's input. Business Associate Agreement (BAA) A Business Associate Agreement is the contract HIPAA requires between a healthcare provider and any vendor that handles protected health information on its behalf. Protected health information (PHI) Protected health information is any information about a person's health, care or payment for care that can be linked to that individual and is held by a healthcare provider, a health plan or one of their vendors. HIPAA-compliant voice AI HIPAA-compliant voice AI is a phone agent operated under a Business Associate Agreement with the safeguards the HIPAA Security Rule requires, including access controls, encryption and audit logging. Call abandonment rate Call abandonment rate is the share of callers who hang up before reaching a person or completing what they called for. Speed to answer Speed to answer is the time between a call starting to ring and someone, or something, answering it. Transfer answer rate Transfer answer rate is the share of transferred calls that are picked up by a person, as opposed to going to voicemail or ringing out. Call routing Call routing is the process of deciding where an incoming call should go and sending it there. Payer calling Payer calling is the phone work a provider's billing team does with insurance companies: checking claim status, verifying benefits, following up on authorizations, denials and appeals. Eligibility and benefits verification Eligibility and benefits verification is confirming, before a service, that a patient's insurance is active and what it covers for that service. Prior authorization Prior authorization is a health plan's requirement that a provider get approval before delivering a particular service, drug or item for it to be covered. Claim denial A claim denial is a payer's decision not to pay a submitted claim, communicated with a reason code. ERA (835) An electronic remittance advice, or 835 file, is the electronic statement a payer sends a provider explaining what was paid, adjusted or denied on each claim. Revenue cycle management (RCM) Revenue cycle management is the set of administrative steps by which a healthcare provider gets paid, from verifying insurance before a visit through billing, follow-up and collection. After-hours answering After-hours answering is how a practice handles calls that arrive when the office is closed: voicemail, an answering service, an on-call rotation or an AI receptionist.